OBJECTIVES: Gout is the most common and progressive arthritic condition. Its severity is assumed to have implications for the humanistic and economic burden of the illness. The objective of this study is to examine the burden of gout between patients with and without tophi using electronic health records (EHR).     METHODS: The Humedica EHR database was searched starting on January 1, 2008 through February 28, 2013 for patients having an initial gout diagnosis (ICD-9 274.xx) and a confirmatory gout diagnosis at least 30 days later.  Deidentified patients with enrollment from 6-months pre/12-months post initial gout diagnosis and at least one serum uric acid (SUA) level were included in the study. Patients (n=933) with a diagnosis of tophaceous gout (274.03, 274.81, and 274.82) during the 12-months post-index period were compared to all other gout (non-tophaceous) patients (n=45,512). Demographic characteristics and comorbidities, SUA levels, and use of colchicine for acute flares during the 12-months post-index period were compared using chi-square tests. RESULTS: Gout patients with tophi were more likely to be female (p<0.01) and have uncontrolled (SUA=6-8) or severely uncontrolled (SUA = >10) SUA (p<0.0001) than patients without tophi.   Colchicine use was higher in patients with tophi (p<.0001). There were  significantly higher levels of cardiovascular comorbidities in the gout patients with tophi vs those without: hypertension (p<0.05), myocardial infarction (p<0.01), atherosclerosis (p<0.0001), dyslipidemia (p<0.0001), peripheral arterial disease (p<0.0001), congestive heart failure (p<0.0001), chronic heart disease (p<0.0001), cardiomyopathy(p<0.0001), ischemic and valvular heart disease (p<0.0001) and left ventricular hypertrophy (p<0.001).  Gout patients with tophi had higher levels of chronic kidney disease, Stages 3-5, (p<0.0001), osteoarthritis (p<0.0001), rheumatoid arthritis (p<0.0001). CONCLUSIONS: Gout patients with tophi had significantly greater burden of disease and greater frequency of comorbidities than those without. Preventing the development of tophi may reduce comorbidities and frequency  of colchicine use and warrants further investigation.